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Shor R, Melo IM, Motekalem Y, Zajner C, Muni RH. Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment in Elderly Patients. Ophthalmol Retina 2023; 7:959-964. [PMID: 37459912 DOI: 10.1016/j.oret.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE To assess clinical outcomes in elderly patients aged ≥ 75 years who underwent pneumatic retinopexy (PnR) for primary rhegmatogenous retinal detachment (RRD). DESIGN Retrospective cohort study. SUBJECTS Patients aged ≥ 75 years with primary RRD undergoing PnR. METHODS This study evaluates clinical outcomes among eligible patients who presented from October 1, 2010, to December 31, 2022, with a minimum of 3 months' follow-up. There were no limitations with respect to the number, size, or location of retinal breaks. Exclusion criteria included significant proliferative vitreoretinopathy or previous retinal detachment repair in the index eye, inability to maintain the postoperative posturing requirements or inability to carry out adequate examination of the peripheral retina because of media opacity. Lens status did not impact the decision to offer PnR. MAIN OUTCOME MEASURES Pneumatic retinopexy primary anatomic reattachment rate and postoperative best corrected visual acuity (BCVA) at 3 months. RESULTS Eighty patients with a mean age of 80.6 ± 4.6 years were included in this study; 35% (28/80) were phakic and 34% (27/80) presented with a fovea-on RRD. The mean number of breaks in the detached retina was 1.52 ± 1.13, and the mean number of quadrants of detached retina was 2.35 ± 0.93. The primary anatomic reattachment rate at 3 months after PnR was 78.8% (63/80), whereas the remaining 21.2% (17/80) failed PnR and underwent an operating room procedure. There was a statistically significant improvement in logarithm of the minimum angle of resolution (logMAR) BCVA from baseline to 3 months (1.29 ± 0.94 and 0.69 ± 0.67, respectively, P < 0.001). A subgroup analysis that only included patients aged > 80 years was also performed, with a total of 39 patients with a mean age of 84.4 ± 3.5 years. The primary anatomic reattachment rate with PnR in this subgroup was 74.4% (29/39), with a statistically significant improvement in BCVA from baseline to 3 months (1.4 ± 1.05 and 0.77 ± 0.70, respectively; P = 0.004). CONCLUSIONS Elderly patients treated with PnR for primary RRD had relatively comparable primary anatomic reattachment rates with other surgical techniques such as pars plana vitrectomy and scleral buckle. Pneumatic retinopexy is an effective, minimally invasive office-based procedure that may be desirable for some elderly patients. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Reut Shor
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Isabela Martins Melo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Yasmin Motekalem
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chris Zajner
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Institute, Toronto, Ontario, Canada.
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Strange Khursandi D, Eley V. 'Quit while you are ahead - and smell the roses!' A survey of retired Fellows of the Australian and New Zealand College of Anaesthetists. Anaesth Intensive Care 2021; 49:379-388. [PMID: 34365806 DOI: 10.1177/0310057x211005783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are no published data on the age of retirement of anaesthetists in Australia and New Zealand. We surveyed 622 retired Fellows of the Australian and New Zealand College of Anaesthetists to determine their ages of complete retirement from clinical practice, demographics, and whether they had retired at the age they had intended to retire. We also aimed to explore factors affecting the decision to retire, the practice of 'winding down', common post-retirement activities, and the arrangement of personal and professional affairs. Responses were received from 371 specialists (response rate 60%). The mean (standard deviation) age of retirement was 65.2 (6.9) years. The mean (standard deviation) retirement ages ranged from 62.0 (7.1) years (those who retired earlier than planned) to 68.0 (4.3) years (those who retired later than they had intended). The mean (standard deviation) age of retirement of the male respondents was 66.0 (6.5) years, and for female respondents was 62.7 (7.7) years. Two hundred and thirty-three respondents (63%) reported winding down their practice prior to retirement, and 360 (97%) had made a will. Poor health and loss of confidence were the two most common factors in the retirement decisions of those who retired earlier than they had planned. Our results may assist current practitioners plan for retirement, and suggest strategies to help health services, departments and private groups accommodate individuals in winding down their practice.
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Affiliation(s)
| | - Victoria Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Münter KH, Clemmesen CG, Foss NB, Palm H, Kristensen MT. Fatigue and pain limit independent mobility and physiotherapy after hip fracture surgery. Disabil Rehabil 2017; 40:1808-1816. [DOI: 10.1080/09638288.2017.1314556] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kristine H. Münter
- Department of Anaesthesiology, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Nicolai B. Foss
- Department of Anaesthesiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Henrik Palm
- Hip Fracture Unit, Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark
| | - Morten T. Kristensen
- Hip Fracture Unit, Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark
- Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark
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Litton E, Baker S, Erber WN, Farmer S, Ferrier J, French C, Gummer J, Hawkins D, Higgins A, Hofmann A, De Keulenaer B, McMorrow J, Olynyk JK, Richards T, Towler S, Trengove R, Webb S. Intravenous iron or placebo for anaemia in intensive care: the IRONMAN multicentre randomized blinded trial. Intensive Care Med 2016; 42:1715-1722. [DOI: 10.1007/s00134-016-4465-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/27/2016] [Indexed: 12/21/2022]
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Earl E, Wong R, Payne MWC. Low vitamin B12 in patients on admission to an amputation rehabilitation unit: a retrospective study. Nutr Clin Pract 2014; 30:122-7. [PMID: 25216737 DOI: 10.1177/0884533614545997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of low vitamin B12 (VB12) in patients on admission to an amputation rehabilitation unit and identify specific populations at risk. METHODS A retrospective chart review was performed for 127 participants comprising patients with major lower limb amputations admitted to a regional amputation rehabilitation program between January 1, 2011 and December 31, 2012. Electronic medical records were reviewed for demographic data, amputation data, medication history, serum VB12 levels, and other related blood work. A literature-based cutoff of VB12 <260 pmol/L was used as the criterion for low VB12. RESULTS The prevalence of low VB12 was 59.8%. Patients aged ≥55 years were found to have an increased prevalence of low VB12 (P = .05). Serum VB12 levels were significantly lower among patients aged ≥55 years (P < .05) and among patients with a mean corpuscular volume >97 fL (P < .01). No other differences in prevalence were determined among different demographics, etiologies, or comorbidities. CONCLUSIONS Patients with an amputation have a high prevalence of low VB12 levels compared with the general population. Low VB12 status may impact rehabilitation outcomes through anemia, cognitive decline, and neuropathy. No reliable indicators for which patients should be screened were found, and therefore, a universal approach to screening and treatment is needed.
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Affiliation(s)
- Eric Earl
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Renee Wong
- Department of Physiology, Western University, London, Ontario, Canada
| | - Michael W C Payne
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada Regional Amputee Program, St Joseph's Health Care, London, Ontario, Canada
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Montano-Pedroso JC, Garcia EB, Omonte IRV, Rocha MGC, Ferreira LM. Hematological variables and iron status in abdominoplasty after bariatric surgery. Obes Surg 2013; 23:7-16. [PMID: 22820956 DOI: 10.1007/s11695-012-0720-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Abdominoplasty, the treatment for abdominal wall deformity stemming from weight loss after bariatric surgery, can cause postoperative anemia. Moreover, bariatric surgery has been associated with iron deficiency, which by itself can compromise erythropoiesis. The objective of this research is to describe the development of anemia after postbariatric abdominoplasty. METHODS The study group consisted of 32 adult women who had received bariatric surgery. Treatment group included 20 patients who were undergoing postbariatric abdominoplasty. Control group included 12 patients waiting for abdominoplasty. Values of hemoglobin, reticulocytes, iron, ferritin, and the transferrin saturation were obtained on the evening before abdominoplasty and during the first, fourth, and eighth postoperative weeks. Hemoglobin was measured at 48 h. RESULTS Mean hemoglobin levels for treatment group decreased from 12.98 to 10.8 g/dL after 48 h, increased on day 7 to 11.53 g/dL, but did not increase further after day 7. The reticulocyte number increased in the first week. Serum iron and transferrin saturation index fell during the first week and remained low. Ferritin levels increased non-significantly from 29.77 to 37.24 ng/mL at week 1, then fell until they were decreased (16.44 ng/mL) by day 56. CONCLUSIONS As expected, hemoglobin fell after abdominoplasty. However, after a one-third recovery of hemoglobin concentrations by week 1 postoperative, they failed to return to preoperative levels by the eighth week. Additionally, by the eighth postoperative week, 45 % of abdominoplasty patients had developed an iron deficiency and hemoglobin deficit that was higher than that of patients who maintained normal iron stocks.
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Affiliation(s)
- Juan Carlos Montano-Pedroso
- Division of Plastic Surgery, Plastic Surgery Post-Graduation Program, Federal University of São Paulo, Rua Napoleão de Barros, 715, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, Brazil.
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Zhao L, Wang F, Gui B, Hua F, Qian Y. Prophylactic lithium alleviates postoperative cognition impairment by phosphorylating hippocampal glycogen synthase kinase-3β (Ser9) in aged rats. Exp Gerontol 2011; 46:1031-6. [DOI: 10.1016/j.exger.2011.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 08/24/2011] [Accepted: 09/06/2011] [Indexed: 12/31/2022]
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Francis JJ, Tinmouth A, Stanworth SJ, Grimshaw JM, Johnston M, Hyde C, Stockton C, Brehaut JC, Fergusson D, Eccles MP. Using theories of behaviour to understand transfusion prescribing in three clinical contexts in two countries: development work for an implementation trial. Implement Sci 2009; 4:70. [PMID: 19852832 PMCID: PMC2777847 DOI: 10.1186/1748-5908-4-70] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 10/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blood transfusion is an essential part of healthcare and can improve patient outcomes. However, like most therapies, it is also associated with significant clinical risks. In addition, there is some evidence of overuse. Understanding the potential barriers and enablers to reduced prescribing of blood products will facilitate the selection of intervention components likely to be effective, thereby reducing the number of costly trials evaluating different implementation strategies. Using a theoretical basis to understand behaviours targeted for change will contribute to a 'basic science' relating to determinants of professional behaviour and how these inform the selection of techniques for changing behaviour. However, it is not clear which theories of behaviour are relevant to clinicians' transfusing behaviour. The aim of this study is to use a theoretical domains framework to identify relevant theories, and to use these theories to identify factors that predict the decision to transfuse. METHODS The study involves two steps: interview study and questionnaire study. Using a previously identified framework, we will conduct semi-structured interviews with clinicians to elicit their views about which factors are associated with waiting and further monitoring the patient rather than transfusing red blood cells. Interviews will cover the following theoretical domains: knowledge; skills; social/professional role and identity; beliefs about capabilities; beliefs about consequences; motivation and goals; memory, attention, and decision processes; environmental context and resources; social influences; emotion; behavioural regulation; nature of the behaviour. The interviews will take place independently in Canada and the UK and involve two groups of physicians in each country (UK: adult and neonatal intensive care physicians; Canada: intensive care physicians and orthopaedic surgeons). We will: analyse interview transcript content to select relevant theoretical domains; use consensus processes to map these domains on to theories of behaviour; develop questionnaires based on these theories; and mail them to each group of physicians in the two countries. From our previous work, it is likely that the theories will include: theory of planned behaviour, social cognitive theory and the evidence-based strategy, implementation intention. The questionnaire data will measure predictor variables (theoretical constructs) and outcome variables (intention and clinical decision), and will be analysed using multiple regression analysis. We aim to achieve 150 respondents in each of the four groups for each postal survey.
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Affiliation(s)
- Jill J Francis
- Health Services Research Unit, University of Aberdeen, UK
| | - Alan Tinmouth
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Canada
- Canadian Blood Services, Ottawa, Canada
| | - Simon J Stanworth
- NHS Blood & Transplant, John Radcliffe Hospital, Headington, Oxford, UK
| | - Jeremy M Grimshaw
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Canada
| | | | - Chris Hyde
- NHS Blood & Transplant, John Radcliffe Hospital, Headington, Oxford, UK
| | - Charlotte Stockton
- Centre for Medical Statistics and Health Evaluation, University of Liverpool, UK
| | - Jamie C Brehaut
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute and Department of Epidemiology and Community Medicine, University of Ottawa, Canada
| | - Dean Fergusson
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Canada
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Pain L, Laalou FZ. [Postanesthesia cognitive dysfunction]. Presse Med 2009; 38:1597-606. [PMID: 19786338 DOI: 10.1016/j.lpm.2009.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/30/2009] [Accepted: 05/04/2009] [Indexed: 11/27/2022] Open
Abstract
The cognitive dysfunctions observed in patients after anesthesia are due not only to the effects of but also to the surgery, the disease requiring surgery, and post-operative treatment. Initial cognitive recovery from anesthetic agents is usually fast, from several hours to several days, but can be delayed by postoperative treatment (analgesia, for example) that have deleterious cognitive effects. During the initial period after surgery, acute impairment of cognitive functions is seen in some patients at risk (major surgery, aged patients, brain sensitivity, or sepsis), specifically transitory (1-3 days in most cases) postoperative delirium. This delirium or confusion requires follow-up at 3 months to check cognitive functions, especially in aged patients. Cohort studies show that cognitive impairment can be objectively identified at one week after surgery with general anesthesia in around 40% of patients, regardless of age. This risk is reduced slightly by the use of loco-regional anesthesia. Cognitive dysfunction is still observed at 3 months after surgery in about 10-15% of patients older than 60 years and in about 6% of younger patients. In patients with a pre-existing cerebral disease with cognitive symptoms, the incidence of long-lasting additional cognitive impairment remains unknown. The mechanisms of this long-term cognitive dysfunction remain to be elucidated.
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Affiliation(s)
- Laure Pain
- Groupe de recherches et d'études sur les répercussions cognitivo-affectives de l'anesthésie, Inserm U666 ; Pôle anesthésie réanimation, CHU de Strasbourg, Faculté de médecine, F-67000 Strasbourg, France.
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Boralessa H, Goldhill DR, Tucker K, Mortimer AJ, Grant-Casey J. National comparative audit of blood use in elective primary unilateral total hip replacement surgery in the UK. Ann R Coll Surg Engl 2009; 91:599-605. [PMID: 19686612 DOI: 10.1308/003588409x432464] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Blood is a scarce and expensive product. Although it may be life-saving, in recent years there has been an increased emphasis on the potential hazards of transfusion as well as evidence supporting the use of lower transfusion thresholds. Orthopaedic surgery accounts for some 10% of transfused red blood cells and evidence suggests that there is considerable variation in transfusion practice. PATIENTS AND METHODS NHS Blood and Transplant, in collaboration with the Royal College of Physicians, undertook a national audit on transfusion practice. Each hospital was asked to provide information relating to 40 consecutive patients undergoing elective, primary unilateral total hip replacement surgery. The results were compared to indicators and standards. RESULTS Information was analysed relating to 7465 operations performed in 223 hospitals. Almost all hospitals had a system for referring abnormal pre-operative blood results to a doctor and 73% performed a group-and-save rather than a cross-match before surgery. Of hospitals, 47% had a transfusion policy. In 73%, the policy recommended a transfusion threshold at a haemoglobin concentration of 8 g/dl or less. There was a wide variation in transfusion rate among hospitals. Of patients, 15% had a haemoglobin concentration less than 12 g/dl recorded in the 28 days before surgery and 57% of these patients were transfused compared to 20% with higher pre-operative values. Of those who were transfused, 7% were given a single unit and 67% two units. Of patients transfused two or more units during days 1-14 after surgery, 65% had a post transfusion haemoglobin concentration of 10 g/dl or more. CONCLUSIONS Pre-operative anaemia, lack of availability of transfusion protocols and use of different thresholds for transfusion may have contributed to the wide variation in transfusion rate. Effective measures to identify and correct pre-operative anaemia may decrease the need for transfusion. A consistent, evidence-based, transfusion threshold should be used and transfusion of more than one unit should only be given if essential to maintain haemoglobin concentrations above this threshold.
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Affiliation(s)
- H Boralessa
- Department of Transfusion Medicine, National Health Service Blood & Transplant, Brentwood, Essex, UK.
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Murphy MF, Brunskill S, Stanworth S, Dorée C, Roberts D, Hyde C. The strengths and weaknesses of the evidence base for transfusion medicine. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1751-2824.2007.00094.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Demeure MJ, Fain MJ. The Elderly Surgical Patient and Postoperative Delirium. J Am Coll Surg 2006; 203:752-7. [PMID: 17084339 DOI: 10.1016/j.jamcollsurg.2006.07.032] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 07/25/2006] [Accepted: 07/26/2006] [Indexed: 12/28/2022]
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